OBJECTIVE: To evaluate the association between lymphopenia and survival in women with cervical cancer treated with primary chemoradiation. METHODS: A single institution, retrospective analysis of patients with stage IB2-IVA cervical cancer who received upfront chemoradiation from 1998 to 2013 was performed. Complete blood counts from pre-treatment to 36 months post-treatment were analyzed. Lymphopenia and known prognostic factors were evaluated for an association with progression-free (PFS) and overall survival (OS). RESULTS: Seventy-one patients met study criteria for whom 47 (66%) had a documented total lymphocyte count (TLC) two months after initiating chemoradiation. FIGO stage distribution was 6% Stage I, 46% Stage II, 45% Stage III and 3% Stage IV. Pre-treatment TLC was abnormal (<1000 cells/mm3) in 15% of patients. The mean reduction in TLC was 70% two months after initiating chemoradiation. Severe post-treatment lymphopenia (TLC <500 cells/mm3) was observed in 53% of patients; they experienced inferior median OS (21.2 vs. 45.0 months, P=0.03) and similar 25th percentile PFS (6.3 vs. 7.7 months, P=0.06) compared to patients without severe lymphopenia. Multivariate analysis demonstrated pre-treatment TLC ≥1000 cells/mm3 and post-treatment TLC >500 cells/mm3 had a 77% (HR: 0.23; 95% CI 0.05-1.03; P=0.053) and 58% decrease in hazards of death (HR: 0.42; 95%CI 0.12-1.46; P=0.17) respectively. CONCLUSION: More than half of cervical cancer patients treated with chemoradiation experienced severe and prolonged lymphopenia. Although statistical significance was not reached, the findings suggest that pre- and post-treatment lymphopenia may be associated with decreased survival. Further research is warranted, given that lymphopenia could be a reversible prognostic factor.
OBJECTIVE: To evaluate the association between lymphopenia and survival in women with cervical cancer treated with primary chemoradiation. METHODS: A single institution, retrospective analysis of patients with stage IB2-IVA cervical cancer who received upfront chemoradiation from 1998 to 2013 was performed. Complete blood counts from pre-treatment to 36 months post-treatment were analyzed. Lymphopenia and known prognostic factors were evaluated for an association with progression-free (PFS) and overall survival (OS). RESULTS: Seventy-one patients met study criteria for whom 47 (66%) had a documented total lymphocyte count (TLC) two months after initiating chemoradiation. FIGO stage distribution was 6% Stage I, 46% Stage II, 45% Stage III and 3% Stage IV. Pre-treatment TLC was abnormal (<1000 cells/mm3) in 15% of patients. The mean reduction in TLC was 70% two months after initiating chemoradiation. Severe post-treatment lymphopenia (TLC <500 cells/mm3) was observed in 53% of patients; they experienced inferior median OS (21.2 vs. 45.0 months, P=0.03) and similar 25th percentile PFS (6.3 vs. 7.7 months, P=0.06) compared to patients without severe lymphopenia. Multivariate analysis demonstrated pre-treatment TLC ≥1000 cells/mm3 and post-treatment TLC >500 cells/mm3 had a 77% (HR: 0.23; 95% CI 0.05-1.03; P=0.053) and 58% decrease in hazards of death (HR: 0.42; 95%CI 0.12-1.46; P=0.17) respectively. CONCLUSION: More than half of cervical cancerpatients treated with chemoradiation experienced severe and prolonged lymphopenia. Although statistical significance was not reached, the findings suggest that pre- and post-treatment lymphopenia may be associated with decreased survival. Further research is warranted, given that lymphopenia could be a reversible prognostic factor.
Authors: Stuart A Grossman; Xiaobu Ye; Glenn Lesser; Andrew Sloan; Hetty Carraway; Serena Desideri; Steven Piantadosi Journal: Clin Cancer Res Date: 2011-07-07 Impact factor: 12.531
Authors: Barbara Bachtiary; Irene Herbacek; Thomas Zideck; Thomas-Hendrik Knocke; Johannes Dimopoulos; Richard Poetter; Michael Micksche Journal: Anticancer Res Date: 2005 Nov-Dec Impact factor: 2.480
Authors: P Lissoni; S Meregalli; E Bonetto; M Mancuso; F Brivio; M Colciago; G Gardani Journal: J Biol Regul Homeost Agents Date: 2005 Jul-Dec Impact factor: 1.711
Authors: Susannah Yovino; Lawrence Kleinberg; Stuart A Grossman; Manisha Narayanan; Eric Ford Journal: Cancer Invest Date: 2013-02 Impact factor: 2.176
Authors: Isabelle Ray-Coquard; Claire Cropet; Martine Van Glabbeke; Catherine Sebban; Axel Le Cesne; Ian Judson; Olivier Tredan; Jaap Verweij; Pierre Biron; Inthidar Labidi; Jean-Paul Guastalla; Thomas Bachelot; David Perol; Sylvie Chabaud; Pancras C W Hogendoorn; Philippe Cassier; Armelle Dufresne; Jean-Yves Blay Journal: Cancer Res Date: 2009-06-23 Impact factor: 12.701
Authors: Aaron T Wild; Xiaobu Ye; Susannah G Ellsworth; Jessica A Smith; Amol K Narang; Tanu Garg; Jian Campian; Daniel A Laheru; Lei Zheng; Christopher L Wolfgang; Phuoc T Tran; Stuart A Grossman; Joseph M Herman Journal: Am J Clin Oncol Date: 2015-06 Impact factor: 2.339
Authors: Grace Lee; Daniel W Kim; Vinayak Muralidhar; Devarati Mitra; Nora K Horick; Christine E Eyler; Theodore S Hong; Lorraine C Drapek; Jill N Allen; Lawrence S Blaszkowsky; Bruce Giantonio; Aparna R Parikh; David P Ryan; Jeffrey W Clark; Jennifer Y Wo Journal: Oncologist Date: 2020-09-12
Authors: Sweet Ping Ng; Houda Bahig; Amit Jethanandani; Courtney Pollard; Joel Berends; Erich M Sturgis; Faye M Johnson; Baher Elgohari; Hesham Elhalawani; David I Rosenthal; Heath D Skinner; G Brandon Gunn; Jack Phan; Steven J Frank; Abdallah S R Mohamed; Clifton D Fuller; Adam S Garden Journal: Radiother Oncol Date: 2020-01-10 Impact factor: 6.280
Authors: Katrin Rabold; Paul R Gielen; Esther D Kers-Rebel; Mihai G Netea; Jan W A Smit; Gosse J Adema; Romana T Netea-Maier Journal: Oncologist Date: 2019-01-03
Authors: Ryoko Suzuki; Steven H Lin; Xiong Wei; Pamela K Allen; James W Welsh; Lauren A Byers; Ritsuko Komaki Journal: Radiother Oncol Date: 2018-02-02 Impact factor: 6.280
Authors: Alexander J Lin; Elizabeth Kidd; Farrokh Dehdashti; Barry A Siegel; Sasa Mutic; Premal H Thaker; Leslie S Massad; Matthew A Powell; David G Mutch; Stephanie Markovina; Julie Schwarz; Perry W Grigsby Journal: Int J Radiat Oncol Biol Phys Date: 2018-11-14 Impact factor: 7.038